[Barriers to psychological safety in long-term care insurance facilities: A qualitative study of directors' perspectives].

Objective　To identify barriers to psychological safety in long-term care insurance facilities through a qualitative descriptive analysis of verbatim transcripts obtained from facility directors.Methods　Directors of long-term care insurance facilities in the Kinki region of Japan were recruited using snowball sampling. Semi-structured interviews were conducted between August and September 2023. Verbatim transcripts were analyzed qualitatively and inductively to generate codes representing statements that impede psychological safety. Codes were iteratively grouped to increase abstraction, forming subcategories and higher-order categories. Findings were further organized according to three antecedent domains: individual, structural/system, and interpersonal factors, to examine how these barriers manifest within facilities.Results　A total of 11 directors participated (9 male; age distribution: 40s, n=5; 50s, n=5). Mean age was 50.0 years (SD=6.44), and mean tenure in the current role was 10.4 years (SD=5.12). Three categories of individual factors were identified: "Position of new employees and junior employees," "Trait of being overly conscious of others and defensive of oneself," and "Difficult work performance among employees suspected of having psychological issues." Three structural/system categories were identified: "Limited understanding and capability regarding managerial duties," "Difficulties in managing, supporting, and training staff," and "Burden due to staff shortages and challenges in appropriate staffing." Five interpersonal categories were identified: "Self-centered and dismissive behavior toward others," "Self-righteous and pressure-generating behavior from superiors," "Intolerance and low flexibility associated with excessive righteousness," "Misunderstandings and concerns arising from insufficient ethical knowledge and rumors," and "Emotionally complex relationships that are difficult to reconcile." Interpersonal factors were prominent and interacted with individual factors. The findings suggested that the lack of effective organizational and workplace structures and systems to address these issues hinders psychological safety in long-term care facilities.Conclusion　Individual, interpersonal, and structural/system factors directly and indirectly inhibit open work-related communication among employees in long-term care insurance facilities. Persistent staffing shortages in Japan further exacerbate these barriers. Enhancing psychological safety requires targeted interventions addressing structural/system factors, particularly leadership practices within management.